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Shelly Mark, Senior Attorney

Video Blog – Request for Reconsideration – Part 2

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Natalia Jofre: Hello, and welcome to Hill & Ponton’s Disability Blog. This is Natalia Jofre. I am the Social Security Section Director here for our firm.
Shelly Mark: I am Shelly Mark. I am the Senior Social Security Attorney with the firm.
Natalia Jofre: In our last blog we talked about if you’re denied you can file an appeal. It’s called a Request for Reconsideration. We made some recommendations regarding how to actually submit that appeal to Social Security and pitfalls that you should basically avoid when doing that. So, now once it’s actually submitted, your local law office is going to forward it to your disability determinations office.
There, it’s going to get assigned to an examiner, and that examiner’s going to look at whether they feel that you are now disabled. So, in other words, they’re going to reevaluate your claim and whatever information you have submitted since the initial application. They’re going to ask you a series of questions. They may send you for a doctor’s evaluation. They will definitely send you forms to complete, which are basically an update of everything you gave them the first time around.
One of the issues that we see a lot of our clients encounter is that they don’t want to complete those forms. They feel like nothing has changed. This isn’t important. Social Security’s playing games. They’re trying to compare what I said now to what I said before and so they’re trying to trick me, and nothing has changed, so I’m not going to fill these out.
Shelly Mark: Right.
Natalia Jofre: Huge mistake.
Shelly Mark: Right.
Natalia Jofre: Right.
Shelly Mark: Yeah. It’s a huge mistake because there’s, the likelihood is that it’s going to be another denial unless there’s some information that would change the examiner’s opinion as to why this decision should now be a favorable decision, when at the initial level it was unfavorable. What happens at that point is that if it is a denial we have to go to the third level of Social Security or the hearing level and request a hearing with an administrative law judge, which is fine; however, there’s a very lengthy wait to actually get the hearing.
Natalia Jofre: Yeah. So, whether it’s a very slim chance that you’re going to be approved at the reconsideration, and that is a reality. On average, 95% of cases are denied again, but the thinking behind that is that I don’t want to complete this because nothing has changed. You really should still complete those forms and submit them, for a couple of reasons.
One being that the longer you take to submit them, the longer Social Security is going to take to issue a decision, so it’s going to increase your wait time. Secondly, if you either don’t fill it out and don’t submit it or don’t respond to their request for contact, they’re going to put in your decision that you were either noncompliant or that you were denied because you didn’t basically give them the information that they wanted, or that you were a contact problem. All of those things will reflect negatively on you and your claim once you have to go before a judge at the hearing level.
Shelly Mark: Definitely. Those forms at the initial and the reconsideration level, they stay part of the file the entire time. Even when we go to hearing, during the hearings on several occasions, judges have referenced them specifically as to whether why didn’t this person go to their examination or why didn’t they complete these forms, or why are their forms different than what they’re saying now at the hearing. So, it’s really important that they are accurate.
Natalia Jofre: I have seen claims where basically the person gets to the hearing level, and if the judge feels that the claim wasn’t evaluated properly or thoroughly at the reconsideration level, we’ve seen them send them back.
Shelly Mark: Mm-hmm (affirmative). Yeah.
Natalia Jofre: I mean, it’s not common but it has happened a few times, and so you should just avoid all that by cooperating with them and giving them what they want at that level.
Shelly Mark: Yeah. Definitely. If you’re represented by an attorney, then if it were our client, we would definitely be encouraging them and advising very strongly to complete the forms or ask us for any assistance with the forms.
Natalia Jofre: Yeah. So, once you submit all of that information, the disability examiner will make a decision. They’ll then send it back to your local office. Your local office will actually issue you the decision, and that’s when you’ll know if you were either approved or denied. Like I said, 95% of cases are denied. So, if that happens, you then need to file another appeal, and I think we’ll talk about that some more in our next blog.
Shelly Mark: Great.
Natalia Jofre: All right. Well, thanks for joining us. If you have any questions, please feel free to contact our office or visit our website. Otherwise, we’ll see you next time.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – SS Request for Reconsideration – Part 1

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Natalia: Welcome to the Hill & Ponton Disability blog. I’m Natalia Jofre, our Social Security Section Director.
Shelly: And I’m Shelly Mark, I’m our Senior Social Security Attorney.
Natalia: We wanted to talk to you today about what happens if you’re denied at the initial level, which we talked about in our last blog, and what your basic options are. If you’re approved, congratulations. It is somewhat of a rarity, because 85% of cases are denied, but if you’re denied then you can file an appeal and request what’s called reconsideration. That will now basically put you at the second level of the social security claims process.
In order to file an appeal, you have to complete very specific forms. You can get these online, you can submit your appeal online, you can go into your local social security office, or you can mail in your appeal. We recommend probably that you file it online because it is the fastest way to submit your appeal and cuts down on your wait time. That’s what we do for our clients. If you go to your local social security office, make sure you get their really early, or perhaps you can try and make an appointment.
If you mail your appeal, we strongly recommend that you send it certified return receipt so that way you have proof that it was actually received by the social security office because-
Shelly: They have a history of not receiving things that are actually sent to them.
Natalia: Right. They lose things a lot, and you don’t want it to come down to your word against there’s because the only options gonna be for you to start all over again. You have 60 days to file an appeal, plus five mailing days. That sounds awkward but it can come in very, very handy because let’s say you get your denial, you get sick, and time sort of passes you by, you had a total of 65 days then however, you want to make sure that it’s actually in their office within that time period because it’s technically 60. Go ahead.
Shelly: One thing that I don’t know about you, but I’ve noticed before is some of our clients may be aren’t at a permanent address while they’re filing their disability claim, and a lot of times at this point in their claim their correspondence may be sending to an address that they’re not at all the time, so they run into issues where they’re not getting the decision in a timely manner so that they can file an appeal.
Just a point to remember, make sure whichever address you’re using with social security is either your address, or if it is a different address, that it’s somewhere that someone’s gonna be notifying them as soon as the documents come in.
Natalia: That’s a really big deal. If you are having your denials or your mail in general sent to a relatives home, or a friends home, make sure that you are checking in with them frequently because social security is not going to accept, “My friend didn’t tell me that I got this denial.” As a reasonable explanation for why you didn’t file an appeal on time.
What they would accept would be something like you were hospitalized and you couldn’t, you physically weren’t able, or you mentally weren’t able. You know, if you were in a psychiatric facility, or if you were in a coma clearly you couldn’t file your own appeal. If it’s basically, “Well you know, my mom got it and she didn’t tell me, or they were on a twiddy house vacation fro two weeks and when we got back the mailbox was full.” None of that’s gonna be a legitimate explanation for them in order to file your appeal late.
I think next we’ll talk about what you actually do, and what actually happens once you file that appeal and where it goes, and what you can expect to happen next in our next blog.
Shelly: That sounds great.
Natalia: All right, great. Well thanks for joining us. If you have any questions feel free to call our office or visit our website.
Shelly: Thank you.
Matthew Hill

Video Blog – What does being found incompetent by the VA mean?

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Matthew Hill: Hello and welcome to another Hill and Ponton Veterans Video Blog. I’m Matthew Hill.
Carol Ponton: Carol Ponton.
Matthew Hill: Today we’d like to talk to you about incompetence and what that means in the VA service connect disability sphere. Essentially the bottom line on that is, it’s a fiduciary incompetence. It’s the VA saying that you as the veteran are not able to handle your benefits, meaning you’re not responsible enough to handle your benefits. Once they make that decision, then it goes from there.
Carol Ponton: A number of things happen that we don’t like for our veterans. One, the VA picks somebody else to handle your money. It could be somebody in your family, or it could be a total stranger you have to pay to handle your money.
The second thing is they take away, or make sure you have no possession of guns. This is something you don’t want to have happen if there’s any way possible, okay. When this usually happens is, if someone has a VA exam by compensation and pension exam, and the doctor checks “you can’t handle your own funds.”
When you go to the VA they’re going to ask you if you’ve had a compensation and pension exam, a mental one. Do you know how much your bills are? Are you able to pay them? Now, if you know, but say you can’t physically write because of your hand, then you say, “Yes, I know how much and my wife helps me because of my hand.”
Don’t set yourself up for being found incompetent, if you really are competent. If you’re found incompetent, what they’ll do is they’ll propose that they’re going to find you incompetent, and they give you time to submit evidence.
What you need to do, is you need to get statements from your wife, your daughter, your husband, to you show that you have been competent all along. If you have a treating VA doctor, that helps a lot for them just to write a statement that says, “I’ve been treating this person for so long, and I feel they are competent to handle their own funds.”
Matthew Hill: Going back to watch Carol just said there, on the C&P exam, and when veterans get tripped up … It’s very common that one person in the marriage is the one who handles all the money, handles all the bills. A lot of times that can be the wife.
What we see a lot is that a veteran says, “My wife handles all the money,” and then the VA doctor on the C&P exam right there, just checks that box, and says “Oh, he can’t handle his funds.” It’s just not true. Just be aware of that when you go in. Don’t fall in the trap. Make sure you tell them,” Look my wife handles the funds because it’s the arrangement we have, but I’m fine with money.”
If you get farther down the line, like Carol was talking about, where they propose incompetency … At that point, what I like to do with our veterans, is to start preparing a record. Either have them go see an outside doctor, to examine him on what he is able to do, or look in their day-to-day bills. Who’s paying the bills? Look at the bank statements. Are there overdraft fees or are there charges that shouldn’t be there?
Carol Ponton: Is their credit good?
Matthew Hill: Yeah. Is their credit good, looking at all that stuff to show, “Well, no, I am competent. There’s no problem with our finances here.”
Carol Ponton: “I submit the credit report. I submit a letter from the family saying who pays the bills, and who’s competent to do that. Usually, we don’t have a problem.” You really don’t want to be found incompetent if you can help it.
Matthew Hill: We’ll say, on the flip side, if you’re just struggling with paying the money … If that’s too much, or just too overwhelming, that’s what the fiduciary is in place for. At that point, you need to decide if there’s somebody in your family that you want to promote to the VA, that should be able to handle your funds, or you just want to go to a professional.
If you can’t handle your funds, what becomes a problem is, is that, people could steal from you. Banks can charge you ridiculous fees. Credit cards could do the same thing. If you need it, it’s there, but that’s something you want to be thinking about going in, versus the VA come at you and say, ” You’re not competent.”
Carol Ponton: Right
Matthew Hill: Well thank you for joining us on the Hill and Ponton Veterans Video Blog. We look forward to seeing on the space further down the line.
Matthew Hill

Video Blog – Common Mistakes – 100% vs Unemployability

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Matthew Hill: Hello I’m Matthew Hill from Hill and Ponton. This is our VA video blog. I’m here with Carol Ponton, and we’re doing a series on the big mistakes we see, or the misunderstandings that get in the way between a veteran and his benefits. Today we want to talk to you about unemployability versus 100%.
  The overwhelming number of clients we represent are so disabled that they can’t work, and we are trying to get them total benefits, be it 100% or unemployability. We are asked all the time …
Carol Ponton: What’s the difference? There’s a schedular 100%, that means you add up all of the ratings you have and they reach 100% …
Matthew Hill: Well, you don’t add them.
Carol Ponton: You combine them.
Matthew Hill: The VA does this percentage math, right.
Carol Ponton: Or you have 100% because you’re not working and you’re not working because of a service connected problem. They’re essentially the exact same thing except under unemployability, you can’t work. That’s the only difference, and you just have to, every year, say I’m not working, and the 100% continues.
Matthew Hill: Well you can work, and we have more information on this on our blog. Check it out. You can work only a little bit, but you are able to work.
Carol Ponton: Right. Basically, they are the same things, but our veterans are very confused about that. They are not sure why is one better than the other. If you want to work and be 100% disabled, then yes, you don’t want the unemployability. If you’re not working because of the service-connected problem, it makes no difference whatsoever if you’re getting unemployability or 100%.
Matthew Hill: Right.
Carol Ponton: That’s the confusion that we have with the clients.
Matthew Hill: If they are permanent and total, they get all the same other benefits: tax breaks …
Carol Ponton: That’s permanent and total. That’s not unemployability and 100%.
Matthew Hill: Right, but it applies to both.
Carol Ponton: Right.
Matthew Hill: You don’t have to be 100% schedular to get that.
Carol Ponton: Right.
Matthew Hill: As far as back to what we were saying as what schedular is and how you combine ratings, we have a VA disability calculator now that actually takes your ratings and combines them just to help. Because a lot of times, we’ll see veterans with ratings that add up to 210%, but they are getting paid 80% or …
Carol Ponton: Not.
Matthew Hill: We’ll link to that in these notes. It’s just important to know to have all options on board.
Carol Ponton: Exactly.
Matthew Hill: If you’re eligible, or you think you’re eligible for 100%, but you might be eligible for IU, we’ll put them out there.
Carol Ponton: IU is unemployability.
Matthew Hill: Unemployability. Don’t take them out just because you don’t think it’s going to be as good getting one benefit or the other because you’re basically tying one hand behind your back.
Carol Ponton: Right.
Matthew Hill: Well, thank you for tuning in on our Hill and Ponton VA blog. We are, again, talking about big mistakes we see that interfere with veterans getting the benefits they deserve.
Matthew Hill

Video Blog – When should you file for unemployability with the VA?

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Matthew Hill: Hello, this is Matthew Hill for the Hill and Ponton VA video blog. I’m here with Carol Ponton and we’re doing a series on what we consider the big mistakes that veterans make that we see again and again that can end up hurting your claim. Today, we want to talk to you about unemployability. There’s always a question as far as when to file unemployability. Just real quick, unemployability is essentially a way to get 100% rating when your combined ratings don’t go up to 100%, but essentially when the VA knows that you can’t work because of your VA disabilities, then they give you unemployability and pay you 100%.
Carol Ponton: You only need to have, you’re not working because of your service connected problem. You get exactly the same benefits as you would for the 100% if the VA, your ratings all added to 100%. It’s a really important benefit, but what we find is people don’t file that. They will file, say a veteran is trying to get a higher rating for PTSD and they can’t work because of the PTSD. As soon as they start filing for PTSD and they’re not working, they should file for unemployability. The unemployability, you file a form. It’s an 8940. You file that. It shows where you last worked and you’re not working now, and you’re not working because of what are the problems. Is it your back? Is it the PTSD?
Now, if you haven’t gotten service connected, say for the PTSD, then they’re going to deny you the unemployability, but when you win your case for PTSD, then that unemployability claim is before them and they have to make a decision. What we find is people wait until they’re service connected. Then they file unemployability and the VA, if they give them benefits, they start it when they file that claim.
Matthew Hill: Right, they do a couple of things. One, they started all over again, but two, they put that claim almost in the back of the line. What Carol’s saying is that if your back’s not service connected right now but you’re filing for it, and that’s what’s keeping you out of work and you file the unemployability, you’ll probably have people say, “Well, what are you doing? You’re not even service connected yet.” Essentially what you’re doing is keeping those two issues together.
Unemployability, according to the Veterans Court, is part in parcel of a claim. It would be part of the back claim implicitly in that it’s just part of the rating, so you were to get service connected and then that’s part of the rating, but what they do is that if you haven’t filed it as its own claim, then even when you get service connected, you file it, they’re going to treat it as a new claim, separate claim, so you wait, but then on top of that they give you the wrong effective date. They say, “Oh, you handed this on January 1, 2017.” Well, you filed the back claim on January 1, 2015. It should go back then. It seems almost counter-intuitive that you would file those two together, but in the long run if you’re saying that this disability, which you will be at service connected, makes it to where you can’t work. You need to file both.
Carol Ponton: You need to. So many times, a veteran will come to me and we’ll get them 70% for PTSD. That 70% automatically should trigger with the VA if the veteran isn’t working right to unemployability, but that’s not how they do it. Every veteran that comes to me and they’re not working, I file a claim for unemployability because it’s really sad to wait years to get 70% for PTSD and then they say, “Okay, now you can file the 8940 and we’ll get to that in a couple of years.” If you have the 8940, then they will handle both things at the same time and the veteran doesn’t have to wait all that time.
Matthew Hill: Right, and you get your benefits and move on with your life. Well, thank you so much for joining us. Again, this was part of our Big Mistakes series. It’s making sure you file you unemployability form when you file your form. Whenever you file any claim, whether it’s for service connection or for increased rating when you believe that claim’s keeping you from working. Thanks.

 
Shelly Mark, Senior Attorney

Video Blog – SS Sequential Eval Process – Step 4 – Skill Level

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Natalia: Welcome to the Hill & Ponton disability blog. I’m Natalia Jofre, the director for our Social Security section here at Hill & Ponton.
Shelly: My name is Shelly Campbell. I’m the senior Society Security attorney here.
Natalia: You’ve watched some of our previous blogs, hopefully, where we talked about the sequential evaluation process. Basically, how does Social Security figure out whether you’re disabled or can meet their disability criteria. We have talked about how work, age, education are also determining factors in evaluating your disability.
Today, we want to talk a little bit more about work. Specifically, skill level, which can you explain what that is?
Shelly: Sure. As Natalia stated, Social Security is going to look at the past work and determine the physical exertion that was required for the work, and also the skill level. We already discussed the physical exertion. The skill level is basically the amount of time that it takes a person to train to be able to acquire the skill set to perform the duties. That’s going to range on a scale of 1 to 10. There is unskilled work, semi-skilled work, and highly skilled work.
Your unskilled work will be work that you could probably learn very quickly and perform quickly. Then, your more highly skilled work is going to be work where you have to have a lot of on-the-job training or formal education.
Natalia: Okay, so let’s go back a little bit. Can you give some examples of semi-skilled versus skilled? Or unskilled?
Shelly: Sure. An unskilled work would probably be that of a cleaner. Now, for semi-skilled, you would get into where if there are more responsibilities as far as organization. You could still have a housekeeper be a semi-skilled position, but it would be more duties involved.
Natalia: So, like if they were a supervisor?
Shelly: Exactly. That’s correct. Then from there, you’re going to move up, depending on the training that’s required. Let’s say an attorney would be a highly skilled position due to the education that’s required, and that would be the same as a mechanic or an electrician because the same education is required, it’s just more on-the-job training.
Natalia: You have- can you say them again?
Shelly: Unskilled, semi-skilled and highly skilled.
Natalia: Okay, so just the three.
Shelly: That’s correct.
Natalia: How does that affect how Social Security evaluates a claim?
Shelly: If Social Security is looking at the claim and the person has performed, say, highly skilled work in the past and they have some limitations that would prevent them from doing that, then in application, Social Security is going to have to determine whether or not they can do work of that skill level or whether they would have to do different work, depending on their limitations.
Natalia: Right. So, if you’re under age 55- we’ll use that as the cutoff- pretty much as long as you can be retrained to do some other type of work, you’re probably not going to be found disabled.
Shelly: Correct.
Natalia: That’s a very general scope blanket statement.
Shelly: One of the most important things with the skill level. If an individual is over 55 and their past work has all been highly skilled work, Social Security is not allowed to say that they can perform other jobs that require less skill. That is one time that performing more highly skilled work is beneficial.
Natalia: Oh, all right. So that can really help them.
Shelly: Definitely.
Natalia: All right. Great. We’re going to talk more about age. Huge determining factor. Yeah. We’ll talk more about age in one of our other blogs, and how that affects your disability or finding a person disabled. But if you have any questions regarding topics we’ve discussed in our blogs, or whether you could potentially qualify for disability benefits, feel free to call our office or visit our website at www.hillandponton.com. Thanks, and we’ll see you next time.
Shelly: Thank you.
Matthew Hill

Video Blog – Common Mistakes – Understand the Goal of Your Claim

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Matthew Hill: Hello and welcome. I’m Matthew Hill with the Hill and Ponton Veteran’s VA Video Blog. I’m here with Carol Ponton, and today we’re continuing a series on big mistakes we see veterans make that really hurt their claim. The one I see a lot that’s kind of hard to understand sometimes is the veteran understanding what the goal is. With the VA benefits, to get VA compensation you got to show a bunch of different things. You got to show something happened in service, that there’s a current disability, that the two are connected, and then what the rating is and then what the effective date is.
We see, a lot of times, veterans coming to us with a denial, say PTSD. They bring us a rating decision they disagree with and they say, “I was denied. When I was in service I was in combat. I saw a lot of action. I had a good friend die.” They tell us just how horrible their experience was. My first response, and I think Carol will do this too, is, “Well, let’s focus on what’s going on here.” That, the VA finally admitted that this is related to service, but the issue now is compensation. They low-balled you on the rating.
Carol Ponton: They gave you a 10% rating.

 
Matthew Hill: Right. The only thing the rating entails is what’s going on now, how is it affecting you now.
Carol Ponton: Right.
Matthew Hill: In a way, it’s kind of moving the ball, in that I see it, the VA can get you to focus on what happened then versus what’s going on now, you’re not going to win the appropriate level of rating.
Carol Ponton: Right, because the issue is what’s going on now. I think with some of my veterans I do like to say, “Show some of the stressors so it’s clear how awful it was, but then we need to focus on right now. What’s happening to you right now?” I want to know from your wife or your significant other, how is this affecting you. I want to know from you. Do you sleep at night? Do you have nightmares? That’s what you need to focus on. That’s one of the biggest problems with PTSD is, most of the time the veterans don’t know what the issue is.
Matthew Hill: Right, and I guess, it’s kind of hard because if you’re fighting for service connection for this issue, whatever it is, you need to talk about what happened in service and you need to have records or buddy statements or statements of friends who knew you then to prove what was going on. Then you have to have a medical link between that and the current disability. Once you get that disability rated, once the VA finally admits, “Okay, this is related to service,” your whole focus needs to be on, “How do I show them how bad it is? My day to day life, how does this affect me?”
You just need to understand that when you’re filing that claim, most likely that’s a claim for an increase or an NOD off an original rating. You need to be thinking, “How is this affecting me and how can I show the VA how bad this is on my life?” We deal a lot with unemployability cases and 100% cases. A lot of times those veterans just, they have such a hard day to day life but they don’t realize it, they’re not focusing on it. They’re focusing on what happened in service, and when they do that they don’t give the VA the evidence they need to rate them at the VA.
Carol Ponton: That’s why a buddy statement, a wife, a special person that’s with you, family members, they see it and they can give us a very good picture. Then that helps us draw out from the veteran, “Tell me what’s going on.” A lot of veterans don’t want to talk about it. I don’t blame them, but this is the one time they need to talk about it in order to get the rating they’re entitled to.
Another area I see this in is, for instance, backs. I will have veterans who are clearly injured, have back injuries in the service, and the VA denies the service connection. The veteran is saying, “Look at my service medical records. They show I was clearly injured. Look it, I just had a third back operation. What’s wrong?” What’s wrong is, remember there are three things you need. Something happened in the service. It’s caused a problem that you have right now, and there’s a nexus, that means there’s a medical opinion that says what happened in the service is causing this problem. You need to focus on what’s missing.
Matthew Hill: Right. As Carol said is it, are they not saying it’s related to service? As she said, if that’s the case, is there evidence of something happening in service? Is there evidence of a current diagnosis? Where we see a lot of problems is, is there a medical opinion linking them? If you have that, and frankly the way to know if you have that if you’re filing a claim is, are they already paying you for it? If they’re already paying you for, we said PTSD 10% or back at 20%, well then the issue now is, how much does it affect you now? That’s where the focus needs to be.
Carol Ponton: Right. I think it’s always worthwhile to have buddy statements, no matter what your problem is. It’s important to have medical evidence backing it up. A psychiatrist, an orthopedic surgeon, whoever is treating you.
Matthew Hill: Well thank you for tuning in Hill and Ponton Video Blog. Again, this was a part of our series of big mistakes the vets make that hurt their claim.
Matthew Hill

Video Blog – Common Mistakes – Appeal vs Reconsideration

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Matthew Hill: Hello, and welcome to another Hill & Ponton Veteran’s Video Blog. I’m Matthew Hill here with …
Carol Ponton: Carol Ponton.
Matthew Hill: Today we’re continuing our series on what we see are big mistakes that veterans make with their claims. This is the third mistake. The first one was not filing a claim, being told that the claim is just not valid, and, therefore, not filing it. The second one was not filing a complete number of claims, meaning you file a claim for your back, but forget to file it for the numbness in your legs, the radiculopathy.
Today, we’re gonna talk about the appeal itself. Once you get a decision, what you need to do after the decision. The two avenues we’ve seen are to appeal it, or to ask for a reconsideration. Carol, what are your thoughts on this?
Carol Ponton: Don’t ask for a reconsideration. That’s my thought. You know, one of the saddest things is that we see people not continue their appeals. If you’re asking for a reconsideration, you’re not appealing. It’s sort of a new claim, a reopened claim, whatever you want to call it. You’ve got to say, “I disagree” and now there’s a form that you have to use.
The saddest thing I see is people are getting advice, wait a year, or a little over a year, and then file a new claim. That means that they’re losing all these past due benefits. The thing you need to do is you need to file a notice of disagreement, and you need to make it’s on the form that the VA requires. Now, so you filed a claim. You’re denied. What do you do then? You file that appeal, but then you need to get evidence. You need to figure out, why is the VA denying you?
Matthew Hill: Right. Well, so with reconsideration, in particular, I talk to veterans about this all the time. They want to have their case reconsidered instead of filing an NOD, because they’re told that it’ll be reviewed faster. I think that’s probably true. I think they’ll get a decision faster than if they enroll in the appeal process and the DRO process like we do, but what’s important to remember is person most likely reviewing your case, if you ask for reconsideration, is the same person who just denied it.
Maybe you have great evidence you’re submitting, and there’s probably a reason to do it, but otherwise, that person’s going to deny it again. All that’s done is put you further back in the line, cause at that point, after your second denial, you’re going to want to appeal, and then you’re in the back of the line again.
Carol Ponton: You may have missed your date, so you’re appealing this most recent decision, instead of the one way back.
Matthew Hill: Yeah, I just don’t see much benefit. One exception that I actually tell veterans to go file a reconsideration is when I look at a decision, and the reason they were denied was failure to show up to an exam. So if I see the vet has a very strong PTSD case, he was actually diagnosed in service, or there’s current diagnosis with strong evidence, and he was denied because he didn’t go to the exam, at that point I’ll say “Look, you don’t need our services right now.”
What you need to do is file a reconsideration, and my hope would be that the C & P exam would be favorable and not only would he get a new decision quickly, but he’d actually start getting benefits.
Carol Ponton: Right.
Matthew Hill: That’s one instance where I definitely recommend doing it, because it’s just not worth waiting all those years if you have an excuse, you have to tell them why you didn’t show up, but give them a valid excuse and then you should be able to get it there.
Carol Ponton: Right.
Matthew Hill: In general, Carol and I adamantly feel that this is such a long process, getting your case won, once you have to appeal. You don’t want to make it longer than you need to.
Carol Ponton: Right.
Matthew Hill: That’s what we see reconsideration doing. So thanks for joining us today. Again, this was our big mistake series, and this was number three, and that is filing reconsideration instead of an NOD.
Carol Ponton: Or not appealing at all.
Matthew Hill: Or not appealing at all.
Matthew Hill

Video Blog – Common Mistakes – Not Filing All Possible Claims

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Matthew Hill: Hello, and welcome to the Hill and Ponton Video Blog. I’m Matthew Hill here with …
Carol Ponton: Carol Ponton.
Matthew Hill: We’re doing a series right now on what we call Big Mistakes with VA Claims, mistakes that we see over and over again and can be fatal to the claim, not just the claim, more importantly to the veteran getting the benefits they deserve. We spoke recently about veterans failing to even make a claim and what that does. Today, we want to talk about not making all the claims.
Carol Ponton: This is what I will typically see. I have a veteran who has hurt his back, clearly related to service, and he continues to try to get the rating for his back higher. The highest rating that most veterans are going to get is 40%.
Matthew Hill: That’s very difficult to get.
Carol Ponton: That’s difficult to get, but what the veterans aren’t realizing is the way that the VA makes up for that is they also give you a rating for things related to the back. If you have radiculopathy, pain, numbness running down your leg into your foot for either leg because of the back, you should file that. The VA doesn’t know what you have unless you tell them. What happens with a lot of veterans, they’ll get 40% for their back, and they may get 40 or 60% for each leg. Say you have dropfoot. You can’t pick up the toe of your foot as you’re walking, and that’s related to your back. You need to claim that.
Incontinence can happen a lot of times with back problems. The other thing I see is depression. If you can’t sit, stand, walk without pain, if you can’t do your job, you’re depressed.
Matthew Hill: Or your life, as you knew it, just doesn’t exist anymore because of that.
Carol Ponton: Then you need to file because if you don’t file, then you can’t get any benefits. That’s how you get complete benefits for the problem that you’ve encountered. If you’re only getting 40% and you can’t work because of your back, that’s really depressing. You need to file for everything that’s related to that service connected problem.
Matthew Hill: I’d say almost a cheat sheet on where to look for that, because what Carol’s talking about, radiculopathy for the legs, radiculopathy in the arms due to a cervical spine, some of that stuff is medical mumbo jumbo, but if you’re treating with the VA, you can ask for your latest records, and they will have a sheet on there that shows all of the problems you have and the medical diagnosis. Those are the ones that you should apply for if you feel like one’s related to the other or if your doc is telling you, “Hey, the pain in your leg is due to the problem you have in your lumbar spine,” but as she said, it’s important to make sure you’ve documented and you filed for all these claims because it’s all the claims together that’s going to get you the highest rating possible.
Carol Ponton: In the past, you could file a 4138 form and just say, “My back is causing me to have problems with my legs, and I’m really depressed.” Now you have to actually file a 21-526 form. What will happen is people will send in a 4138, this form that outlines, it’s a story about what’s going on with the veteran. The veteran sends it, and then the VA, instead of processing a claim, they’ll send back, “Did you want to file a claim? If you did, you have to file it on this form.” If you’re not filing it on the form, you’re not filing a claim. Make sure you list every one of those problems.
Matthew Hill: Back to listing those problems, you do not have to list the medical term. If your leg hurts, it’s going numb, you can put that. If you know the word radiculopathy, great, but if you don’t, you need just describe what you’re feeling, sensation. If you feel depressed, you don’t know the correct medical condition, mental health condition that is, you can say, “Have no motivation. I don’t want to be around people.” Just whatever it is, don’t be frightened by having to use the right words. Just put it down so that the burden then goes on the VA to develop the evidence to grant you the
Carol Ponton: If you can’t work, make sure you put, “I can’t work because of this.”
Matthew Hill: Thank you all for joining us this time. This is our small series on big mistakes we see, and this was mistake number two, not filing all your claims. Thanks.
Matthew Hill

Video Blog – Filing a Complete VA Claim

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Matthew Hill: Hello and welcome to the Hill and Ponton VA video blog. I’m Matthew Hill.
Carol Ponton: I’m Carol Ponton.
Matthew Hill: Today we want to talk to you about filing a claim and what we would call filing a complete claim. What that means is when a veteran files a claim they typically file it for one disability. Let’s say for diabetes. A lot of disabilities like diabetes are almost a gateway. In that, that disability is a disability in and of itself but it causes, one, two, three, four, five other ones.
Carol Ponton: The veterans, when you file your claim if you file for diabetes than the VA is going to say, “Okay great, do you take insulin? Do you not take insulin? I’m going to give you ten, twenty, maybe forty percent.” The real problem with diabetes that you know is that it causes so many other problems. You can have no feeling in your fingers, your arms, your feet, your legs. That’s the peripheral neuropathy. You have to put the VA on notice that this is what you’re filing for. “I don’t have any feeling in my feet. I can’t pick up my foot. I step on nails. I have ulcers in my legs.” What if it’s affected your kidney. There are so many things that diabetes does to you. You have to file for all of those things. The VA is supposed to look. They’re supposed to. They’re busy.
  They look at what you ask for and that’s what they deal with. It’s really important that you make them know what’s going on. Erectile dysfunction, do you have that because of diabetes? Do you have depression because of diabetes? Make sure that you list. A lot of times it’s good to ask your spouse or your significant other, “What problems do you think I have or should we list because of this one thing?” Let’s talk about the back. You have a back problem, but maybe that means you have foot drop. You can’t pick up your foot or if you have a neck problem. Does that affect your hands and being able to use them? Think about what the problem is and all of the other problems it causes you. Make sure you list every single one of those on that claim.
Matthew Hill: This can be overwhelming. Think about it. I would suggest a place to start would be to get a copy of your medical records. See what your doctor has diagnosed you with. Talking to your doctor about this, what he thinks is involved with diabetes, asking him what are the other issues? If you can’t do that get a copy of your medical records and see which ones are related. Carol was talking about the orthopedic issues. Frankly if you have a back problem and you’re suffering from anything else, a knee, an ankle, a hip you should probably file for that too because there’s a strong likelihood that they’re related. When I say they’re related. You can get secondary service connection meaning the knee was never a problem in service. There was never an accident from the knee. If the back either caused or aggravated the current knee injury they need to compensate you for that.
Carol Ponton: They will. It’s just making sure that it’s clear, what you’re asking for.
Matthew Hill: That’s just a word of advice when you’re filing a new claim. Take the time to sit there and think about what all this claim encompasses. How this affects your whole body? One we don’t see enough is that when the veteran does have a back claim and their legs don’t work and they lost their job because of it. One thing they don’t put down, which after talking to them a lot of times you’ll see is depression. They’ll be depressed just because their whole life was altered by their disability. Again it’s a total body, total system review you need to do before you put down a claim because as we know and you probably know as well these claims don’t get solved right away. You want everything in there.
Carol Ponton: So that when you get your benefits and go back to the day that you filed your claim. Remember you can look at the rating decision. The highest rating most people get that we know for diabetes is usually 40%. There’s a higher rating, but most people don’t get anything higher than that because the VA has already done another rating for the peripheral neuropathy, for the loss of kidney function. You’re going to get higher ratings by getting all of those included in that rating.
  I would want to say one thing about diabetes that over and over again most people that have diabetes and have a kidney problem don’t even know it. You need to learn to read your blood labs. If you have a BUN or creatinine problem it could be related to diabetes. Most people don’t find that out until its really really late. Ask your doctors, learn how to read those labs. That’s a 60% rating just for your kidney function if you’ve had that. Most of the time when my clients have it, it’s news to them. Make sure you know what’s going on.
Matthew Hill: Thank you for joining us today. We look forward to seeing you again on this space.